按照基线氧合指数诊断的中度和重度急性呼吸窘迫综合征婴幼儿的临床特点和预后比较  

Comparison of clinical characteristics and outcomes of infants with moderate and severe acute respiratory distress syndrome diagnosed according to baseline oxygenation index

作　　者：方伯梁[1] 李科纯 许峰[2] 陆国平 任晓旭[4] 张育才[5] 靳有鹏 王莹[7] 刘春峰[8] 成怡冰 杨巧芝[10] 肖曙芳[11] 杨镒宇 霍习敏[13] 雷智贤 党红星[2] 刘霜[4] 武志远 曾健生[1] 钱素云[1] Fang Boliang;Li Kechun;Xu Feng;Lu Guoping;Ren Xiaoxu;Zhang Yucai;Jin Youpeng;Wang Ying;Liu Chunfeng;Cheng Yibing;Yang Qiaozhi;Xiao Shufang;Yang Yiyu;Huo Ximin;Lei Zhixian;Dang Hongxing;Liu Shuang;Wu Zhiyuan;Zeng Jiansheng;Qian Suyun(Department of Pediatric Intensive Care Unit,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;Department of Pediatric Intensive Care Unit,Children′s Hospital of Chongqing Medical University,Chongqing 400014,China;Department of Pediatric Intensive Care Unit,Children′s Hospital of Fudan University,Shanghai 201102,China;Department of Pediatric Intensive Care Unit,Children′s Hospital Affiliated to Capital Institute of Pediatrics,Beijing 100020,China;Department of Critical Care Medicine,Shanghai Children′s Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200062,China;Department of Pediatric Intensive Care Unit,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250012,China;Department of Pediatric Critical Care Medicine,Shanghai Children's Medical Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Department of Pediatric Intensive Care Unit,Shengjing Hospital of China Medical University,Shenyang 110004,China;Department of Pediatric Intensive Care Unit,Children's Hospital Affiliated to Zhengzhou University,Zhengzhou 450052,China;Department of Pediatric Intensive Care Unit,Liaocheng People's Hospital,Liaocheng 252000,China;Department of Pediatric Intensive Care Unit,Kunming Children's Hospital,Kunming 650034,China;Department of Pediatric Intensive Care Unit,Guangzhou Women and Children's Medical Center,Guangzhou 510623,China;Department of Pediatric Intensive Care Unit,Hebei Children's Hospital,Shijiazhuang 050031,China;Department of Pediatric Intensive Care Unit,Hainan Women and Children's Medical Center,Haikou 570206,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院重症医学科,100045 [2]重庆医科大学附属儿童医院重症医学科,400014 [3]复旦大学附属儿科医院重症医学科,上海201102 [4]首都儿科研究所附属儿童医院重症医学科,北京100020 [5]上海市儿童医院重症医学科,200062 [6]山东第一医科大学附属省立医院小儿重症医学科,济南250012 [7]上海交通大学医学院附属上海儿童医学中心重症医学科,200127 [8]中国医科大学附属盛京医院小儿急诊急救内科,沈阳110004 [9]郑州大学附属儿童医院重症医学科,450052 [10]聊城市人民医院重症医学科,252000 [11]昆明市儿童医院重症医学科,650034 [12]广州妇女儿童医学中心重症医学科,510623 [13]河北省儿童医院重症医学科,石家庄050031 [14]海南省妇女儿童医学中心重症医学科,海口570206

出　　处：《中国小儿急救医学》2023年第8期561-565,共5页Chinese Pediatric Emergency Medicine

基　　金：吴阶平医学基金会临床科研专项(320.6750.17192);国家临床重点专科建设项目(国卫办医函[2021]451号)。

摘　　要：目的分析儿童重症监护病房(PICU)内按基线氧合指数(OI)诊断中度和重度儿童急性呼吸窘迫综合征(PARDS)婴幼儿的临床特点和预后差异。方法对"肺表面活性物质治疗婴幼儿中重度ARDS疗效分析"研究所建立的临床数据库资料进行二次分析。回顾性比较2016年12月至2021年12月收住中国14家三级甲等医院PICU的101例按基线OI诊断的中度和重度PARDS婴幼儿在一般情况、基础疾病、OI、机械通气、肺表面活性物质应用、预后等临床资料方面的差异。结果101例患儿中,中度和重度PARDS患儿分别为55例(54.5%)和46例(45.5%)。重度组男性比例(50.0%比72.7%,P=0.019)及小儿危重病例评分[72(68,78)分比76(70,80)分,P=0.019]均显著低于中度组,而年龄、体重、致PARDS病因、基础疾病等两组比较差异无统计学意义(P>0.05)。重度组患儿高频呼吸机使用率显著高于中度组(34.8%比10.9%,P=0.004),但肺表面活性物质使用情况、液体负荷及肺部并发症比较差异无统计学意义(P>0.05)。重度组患儿24 h OI改善程度[0.26±0.33比0.04±0.34,P=0.001]和72 h OI改善程度[0.34(-0.04,0.62)比0.15(-0.14,0.42),P=0.029]均显著优于中度组,但两组患儿间的病死率、确诊PARDS后住院时间和呼吸机治疗时间等比较差异无统计学意义(P>0.05)。结论在有创机械通气的中度和重度PARDS婴幼儿中,按基线OI诊断的重度PARDS患儿治疗早期氧合改善优于中度患儿,也更可能接受高频通气治疗。基线OI并不能敏感区分此类患儿预后,并非此类患儿PARDS分度的理想指标。Objective To analyze the difference of clinical characteristics and outcomes of infants with moderate and severe pediatric acute respiratory distress syndrome(PARDS)diagnosed according to baseline oxygenation index(OI)in pediatric intensive care unit(PICU).Methods Second analysis of the data collected from the"Efficacy of pulmonary surfactant(PS)in the treatment of children with moderate and severe ARDS"program.Retrospectively compare of the differences in clinical data such as general condition,underlying diseases,OI,mechanical ventilation,PS administration and outcomes among infants with moderate and severe PARDS divided by baseline OI who admitted to PICUs at 14 participating tertiary hospitals from 2016 to December 2021.Results Among the 101 cases,55 cases(54.5%)were moderate and 46 cases(45.5%)were severe PARDS.The proportion of male in the severe group(50.0%vs.72.7%,P=0.019)and the pediatric critical illness score(PCIS)[72(68,78)vs.76(70,80),P=0.019]were significantly lower than those in the moderate group,while there was no significant difference regarding age,body weight,etiology of PARDS and underlying diseases.The utilization rate of high-frequency ventilator in the severe group was significantly higher than that in the moderate group(34.8%vs.10.9%,P=0.004),but there was no significant difference in PS use,fluid load and pulmonary complications.The 24 h OI improvement(0.26±0.33 vs.0.04±0.34,P=0.001)and the 72 h OI improvement[0.34(-0.04,0.62)vs.0.15(-0.14,0.42),P=0.029)]in the severe group were significantly better than those in the moderate group,but there was no significant difference regarding mortality,length of hospital stay and intubation duration after diagnosis of PARDS between the two groups.Conclusion In moderate and severe(divided by baseline OI)PARDS infants with invasive mechanical ventilation,children in severe group have better oxygenation improvement in the early stage after PARDS identified and are more likely to receive high frequency ventilation compared to those in moderate group.B

关 键 词：儿科 重症监护病房 机械通气 急性呼吸窘迫综合征 氧合指数 

分 类 号：R725.6[医药卫生—儿科]